Endocrine Abstracts

Objective: Describe clinical features and therapeutic modalities of diabetic patients hospitalized for necrotizing otitis externa in our department.

Materials and methods: Retrospective study about 19 diabetic patients treated for necrotizing otitis externa in our department over a period of 7 years (2016 - 2022). All patients had a bacteriological and mycological otorrhea sampling, computed tomography and laboratory test.

Results: The average age of our patients was 60 years old (22-91 years old) with female predominance. Severe otalgia resistant to standard treatments was observed in all cases. Two patients suffered from facial palsy. All patients received pre-hospital antibiotic therapy for an average duration of 7 days (5 – 21 days). The average time for germ isolation was 4 months (3 days – 3 months). The bacteriological study of the initial samples was positive in 12 cases. The most common germ was Pseudomonas Aeruginosa (9 cases). 4 patients had an aspergillary infection (fungal transformation in 3 cases). Aspergillus serology was positive in two patients who still had negative samples. Treatment was based on parenteral antibiotic therapy combining a Fluoroquinolone (Ofloxacin) with a Third Generation Cephalosporin (Ceftazidim) or a Carbapenem in the majority of cases, with an average duration of 45 days. The fungal forms received antifungal treatment (Itraconazole) for an average duration of 3 months (66 days– 5 months). The evolution was favorable in all cases. No recurrence was noted with an average follow-up of 15 months.

Conclusion: Necrotizing otitis externa represents a diagnostic and therapeutic challenge for any ENT practitioner. Fungal forms are clearly on the rise. The multiplicity of bacteriological and mycological samples improves the rate of positive results and establishes the appropriate treatment.